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Grochowska A, Arkuszewski P. Rupture of an accessory spleen caused by blunt trauma. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02591-y. [PMID: 38980393 DOI: 10.1007/s00068-024-02591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The accessory spleen is quite a common abdominal anomaly. However, the traumatic accessory spleen rupture is an extremely rare condition requiring surgical intervention, even laparotomy. 9 cases of traumatic accessory spleen were found published between 1962 and 2022. The study aims to evaluate traumatic accessory spleen rupture cases regarding their causes, clinical course, and possible diagnosis without surgery and treatment. METHODS Desk research method using available online databases. Descriptive methods were employed to analyze the collected data. The results are summarized in the Table concerning gender, age, injury details, accessory spleen injury characteristics, treatment, and others such as previous splenectomy or primary spleen involvement in injury or accompanying abdominal injuries. RESULTS In total, there were 9 cases of traumatic accessory spleen, of which 2 were managed conservatively and the remaining 7 were treated operatively. All the patients survived. One-third of all included patients already had their primary spleen removed, which facilitated the diagnosis of traumatic rupture of an accessory spleen. The proper diagnosis of an accessory spleen rupture was concluded in 2 cases and confirmed in surgery. CONCLUSION The recognition of the traumatic rupture of an accessory spleen before surgery is challenging but can be made easier if the patient underwent splenectomy before. The traumatic accessory spleen rupture does not coexist with an injury of a primary spleen.
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Affiliation(s)
- Agata Grochowska
- Department of Biomedicine and Experimental Surgery, Student Scientific Club of Biomedicine and Experimental Surgery, Medical University of Lodz, 60 Narutowicza Street, Lodz, 90-136, Poland
| | - Piotr Arkuszewski
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, 60 Narutowicza Street, Lodz, 90-136, Poland.
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2
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Ghuman N, Atagu N, Sachdev R, Covarrubias O, Gregg L, Brookmeyer C, Johnson P, Gomez E. 'That's just the Ovary!' and other cases of mistaken identity on CT of the female pelvis. Curr Probl Diagn Radiol 2024; 53:422-435. [PMID: 38365459 DOI: 10.1067/j.cpradiol.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
CT is often the first imaging test in female patients with lower abdominal and pelvic pain because of the wide availability of CT and differential diagnoses that span both gynecologic and gastrointestinal disease. Pathology within the female pelvis may be difficult to diagnose on CT owing to suboptimal delineation of anatomy in comparison to MRI and ultrasound. These challenges are confounded by overlapping imaging features of a wide range of gynecologic entities and can lead to diagnostic dilemmas. High value CT interpretation will direct the clinician to the best next diagnostic step as ultrasound and MRI provide superior soft tissue delineation. Other imaging modalities, laboratory investigations, or tissue sampling may be necessary to definitively characterize indeterminate lesions. In this review, we illustrate various cases of mistaken identity on CT of the female pelvis involving the ovaries, uterus, and peritoneal cavity while highlighting clinical pearls that may aid the radiologist in arriving at the correct diagnosis and avoiding potential pitfalls.
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Affiliation(s)
- Naveen Ghuman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norman Atagu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahul Sachdev
- St.Agnes Medical Center, Department of Internal Medicine, Fresno, CA, USA
| | - Oscar Covarrubias
- Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lydia Gregg
- Johns Hopkins Department of Art as Applied to Medicine and Division of Interventional Neuroradiology, Baltimore, MD, USA
| | - Claire Brookmeyer
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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3
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Gil J, Suh M, Choi H, Paeng JC, Cheon GJ, Kang KW. [ 18F]FDOPA PET/CT in Solid Pseudopapillary Tumor of the Pancreas: a Recurred Tumor Mimicking Splenosis. Nucl Med Mol Imaging 2024; 58:81-85. [PMID: 38510822 PMCID: PMC10948710 DOI: 10.1007/s13139-023-00826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 03/22/2024] Open
Abstract
Solid pseudopapillary tumor (SPT) of the pancreas is a neoplasm with low malignant potential. It is often challenging to diagnose SPT due to its nonspecific clinical and radiological features, and [18F]FDOPA is effective in diagnosing SPT, particularly in differentiating SPT from benign conditions such as splenosis. A 55-year-old woman underwent distal pancreatectomy and splenectomy for histologically confirmed SPT. She was also initially diagnosed with splenosis. During follow-up, sizes of multiple nodular lesions were increased, raising the possibility of peritoneal seeding of SPT. For diagnosis, a spleen scan and SPECT/CT were performed using 99mTc-labeled damaged red blood cells, which showed no uptake in the peritoneal nodules. Subsequent [18F]FDOPA PET/CT revealed [18F]FDOPA-avidity of the nodules. The patient underwent tumor resection surgery, and the nodules were pathologically confirmed as SPT.
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Affiliation(s)
- Joonhyung Gil
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Minseok Suh
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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4
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Yang JZ, Lim MC, Teo YM, Lee YY. Clinics in diagnostic imaging (218). Singapore Med J 2024; 65:45-50. [PMID: 38212984 PMCID: PMC10863738 DOI: 10.4103/singaporemedj.smj-2022-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 01/13/2024]
Affiliation(s)
- James Zheng Yang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Mei Chin Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Yi Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Yang Yang Lee
- Department of Paediatric Surgery, National University Hospital, Singapore
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5
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Julian K, Vasekar M. Thoracic splenosis: an important consideration in oncology patients. BMJ Case Rep 2023; 16:e257091. [PMID: 37940196 PMCID: PMC10632802 DOI: 10.1136/bcr-2023-257091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
SummarySplenosis is the implantation of ectopic splenic tissue after splenic injury or splenectomy. Signs and symptoms of splenosis vary based on anatomic location; however, it remains asymptomatic in many cases. On radiographic imaging, splenosis often appears as a soft tissue mass and can be diagnosed using heat-damaged red blood cell scintigraphy, a non-invasive imaging modality. Radiographic findings of splenosis on imaging may be suspicious for metastatic disease in patients with known solid organ tumours. It is important to have a high degree of suspicion for splenosis with known history of splenic trauma or splenectomy in order to avoid invasive procedures and guide appropriate management.
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Affiliation(s)
- Katherine Julian
- Internal Medicine, University of Colorado, Aurora, Colorado, USA
| | - Monali Vasekar
- Hematology/Oncology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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6
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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7
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Orminski K, Monnett SW, Richmond BK. Small Bowel Obstruction due to Splenosis Mimicking Periduodenal Mass. Am Surg 2023; 89:1127-1128. [PMID: 33342247 DOI: 10.1177/0003134820971587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Krysta Orminski
- West Virginia University School of Medicine/Charleston Campus, WV, USA
| | - Shane W Monnett
- Department of Surgery, West Virginia University School of Medicine/Charleston Division, WV, USA
| | - Bryan K Richmond
- Department of Surgery, West Virginia University School of Medicine/Charleston Division, WV, USA
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8
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Boerkamp A, Das A, De Robles MS. Unexpected post-operative haemorrhage: Could it be splenosis? J Surg Case Rep 2022; 2022:rjac540. [PMID: 36589686 PMCID: PMC9797326 DOI: 10.1093/jscr/rjac540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 12/30/2022] Open
Abstract
Ectopic splenic tissue can be classified as accessory spleen, polysplenia or a phenomenon termed as splenosis. Once believed a rare occurrence, the incidence of splenosis is now thought to be significantly higher. Generally, splenosis is asymptomatic and discovered incidentally during operation, imaging or at autopsy. The case presented herein describes an incidental finding of an intraabdominal splenosis, which was subsequently biopsied to investigate for peritoneal metastatic disease. The biopsied tissue subsequently caused significant post-operative haemorrhage. Past medical history and specific pre-operative imaging modalities for patients presenting with asymptomatic peritoneal or intra-abdominal nodules are discussed. Splenosis is highlighted as a common condition to consider prior to invasive investigations.
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Affiliation(s)
- Andrea Boerkamp
- Correspondence address. Department of Surgery, Shoalhaven District Memorial Hospital, Scenic Drive, Nowra, New South Wales 2541, Australia. Tel: +61-2-4421-3111; Fax: +61-2-4421-4967; E-mail:
| | - Ashwin Das
- Department of Anatomical Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Marie Shella De Robles
- Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia,Graduate School of Medicine, University of Wollongong, Keiraville, New South Wales, Australia,Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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9
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Alves FB, Rombo DM, Veiga V, Correia PS, Salgado L, Cunha TM. Abdominal splenosis mimicking peritoneal carcinomatosis of ovarian cancer. Radiol Case Rep 2022; 18:932-935. [PMID: 36593917 PMCID: PMC9803607 DOI: 10.1016/j.radcr.2022.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/28/2022] Open
Abstract
We present the clinical case of a 53-year-old woman referred for suspicion of recurrence of a mesonephric-like adenocarcinoma of the ovary. Abdominal and pelvic CT revealed multiple round/oval solid nodules with similar density scattered throughout the abdomen and pelvis, the biggest ones appearing in the left hypochondrium; no normal-appearing spleen or ascites were observed. These radiological findings and the absence of significant elevation of CA 125 levels made the radiologists hypothesize that these aspects were related to abdominal splenosis. They asked the patient about previous medical history of splenic injury, which she confirmed, referring it was a consequence of a remote major trauma. A 99mTc-labeled heat-denatured erythrocytes (99mTc-DRBC) scintigraphy/ hybrid SPECT/CT was then performed for definitive diagnosis; it showed spleen remnants as foci of increased radiopharmaceutical uptake in the same locations as the nodules appearing in the CT. This diagnostic work-up was consistent with abdominal splenosis, mimicking peritoneal carcinomatosis of ovarian cancer.
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Affiliation(s)
- Filipe Barros Alves
- Department of Radiology, Centro Hospitalar Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal,Corresponding author.
| | - Diogo M. Rombo
- Department of Nuclear Medicine, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Vera Veiga
- Department of Ginecology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Paulo Santos Correia
- Department of Radiology, Centro Hospitalar e Universitário de Lisboa Central – Hospital de S. José, Rua José António Serrano, 1150-199 Lisboa, Portugal
| | - Lucília Salgado
- Department of Nuclear Medicine, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
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10
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Calcification in Thoracic Splenosis. Case Rep Pulmonol 2022; 2022:9538355. [PMID: 36267804 PMCID: PMC9578903 DOI: 10.1155/2022/9538355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Splenosis is a rare condition described as the implantation of ectopic splenic tissue, usually after a splenic rupture. Thoracic splenosis refers to acquired ectopic splenic tissue found within the thoracic cavity, often caused by thoracoabdominal trauma or surgery. Most cases are asymptomatic and many years may elapse before they are incidentally discovered on chest radiography or thoracic computed tomography. Splenosis is often misinterpreted as a malignancy on initial imaging. We wish to highlight a rare case of thoracic splenosis presenting with calcified and non-calcified nodules. Only two other cases of calcification have been reported in intrathoracic splenosis, neither of which provided CT images of this finding.
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11
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Subcutaneous Splenosis Presenting 37 years post-traumatic splenectomy; A Case Report. Int J Surg Case Rep 2022; 94:107018. [PMID: 35397300 PMCID: PMC8987990 DOI: 10.1016/j.ijscr.2022.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The term splenosis refers to autotransplantation of splenic tissue in ectopic sites. Ectopic splenic tissue may be found in the liver, thorax, pelvis and subcutaneous tissues following traumatic splenectomy. Although clinically insignificant, local symptoms such as abdominal pain may arise. In this paper we report a case of subcutaneous splenosis presenting 37 years post-traumatic splenectomy. CASE PRESENTATION A 40-year-old medically free lady presented to our institution with a surgical history of post-traumatic splenectomy at the age of three and two cesarean sections. She complained for nonpainful right upper quadrant soft mass that has been stable in size over the years. Her laboratory results, including peripheral blood smear, were all within normal limits and no asplenic changes were detected. SPECT scan confirmed extraperitoneal splenosis in right upper quadrant. DISCUSSION Splenosis is an acquired form of ectopic splenic tissue that is defined as an auto-transplantation of a viable splenic tissue. It commonly occurs after traumatic rupture of the spleen.5 Splenosis has been widely reported around the world with an incidence of 16-67% after traumatic splenic rupture or splenectomy. Subcutaneous splenosis is an extremely rare condition, mostly observed in abdominal surgical scars. It is believed to follow laparotomy for splenectomy where splenic cells auto-implant or spread hematogenously at different locations. CONCLUSION Subcutaneous splenosis is a rare consequence of post-traumatic splenectomy that can manifest itself up to three decades after. Although concerning to the patient and alarming to the surgeon as it may resemble more serious entities such as abdominal wall sarcoma, surgical removal of asymptomatic splenosis is subject to the location of mass and patients' wishes.
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Smoot T, Revels J, Soliman M, Liu P, Menias CO, Hussain HH, Savas H, Gaballah AH. Abdominal and pelvic splenosis: atypical findings, pitfalls, and mimics. Abdom Radiol (NY) 2022; 47:923-947. [PMID: 35076742 DOI: 10.1007/s00261-021-03402-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/28/2023]
Abstract
Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.
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Affiliation(s)
- Travis Smoot
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Hero H Hussain
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA.
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Prieto García B, González Santiago JM, Gómez-Caminero López F. Splenosis as an incidental finding in a patient with multifactorial anemia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 115:188-189. [PMID: 35469404 DOI: 10.17235/reed.2022.8733/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A clinical case of a patient from our institution under study for anemia of multifactorial origin in whom splenosis was detected as an incidental finding.
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14
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TOMURA S, TOSHIMA A, NOMURA A, HIRATA M, YAMAGAMI T, KAGAWA Y, KADOSAWA T. Intrapancreatic accessory spleen mimicking pancreatic insulinoma with intrapancreatic metastasis in a cat. J Vet Med Sci 2022; 84:439-444. [PMID: 35110461 PMCID: PMC8983289 DOI: 10.1292/jvms.21-0584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An 11-year-old neutered male Domestic Shorthair cat presented with a 3-month history of hypoglycemia, two episodes of seizure, and intermittent tick-like signs. Serum biochemistry revealed severe hypoglycemia associated with high insulin concentrations. Dynamic abdominal computed tomography (CT) indicated two pancreatic masses, which were enhanced most during the late arterial phase but had different degrees and variations of attenuation. Partial pancreatectomy was performed. Histopathology and immunohistochemistry confirmed that one mass was an insulinoma and the other was an ectopic splenic tissue, consistent with the differences in imaging findings. When an intrapancreatic lesion with hyper-attenuation on dynamic abdominal CT is detected, not only insulinoma or metastasis of malignancies but also intrapancreatic accessory spleen (IPAS) should be considered as differential diagnoses.
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15
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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16
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Battiato P, Salgüero R, Specchi S, Longo M. Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog. Vet Radiol Ultrasound 2021; 63:E1-E5. [PMID: 34240502 PMCID: PMC9290587 DOI: 10.1111/vru.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
An 8‐year‐old mixed breed dog, was referred for lethargy, abdominal discomfort, hematemesis, and melena. Abdominal ultrasound revealed mineralization of the “right splenic vein” with collateral spiraling and a suspected splenic duplication. Computed tomography confirmed the duplication along with torsion of the splenic pedicle. Exploratory laparotomy confirmed the splenic torsion associated with congestion of the gastrointestinal vessels, indicative of a chronic onset of secondary regional splenic vein hypertension.
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Affiliation(s)
- Pierantonio Battiato
- Diagnostic Imaging Department, Veterinary Teaching Hospital, University of Milan, Lodi, Italy.,Diagnostic Imaging Department, Hospital Veterinario Puchol, Madrid, Spain.,Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Milan, Italy
| | - Raquel Salgüero
- Diagnostic Imaging Department, Hospital Veterinario Puchol, Madrid, Spain
| | - Swan Specchi
- Diagnostic Imaging Department, Ospedale Veterinario I Portoni Rossi, Bologna, Italy
| | - Maurizio Longo
- Diagnostic Imaging Department, Veterinary Teaching Hospital, University of Milan, Lodi, Italy.,Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Milan, Italy
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17
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Richardson L, Gardner K, Eberhardt S, Thompson W. A case of hepatic splenosis in the setting of iron overload; multimodal and literature review. Radiol Case Rep 2021; 16:2499-2504. [PMID: 34257788 PMCID: PMC8259227 DOI: 10.1016/j.radcr.2021.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Hepatic splenosis, a rare entity, is the ectopic implantation of splenic tissue into the hepatic parenchyma, most often incidentally seen in patients with a history of splenic trauma and splenectomy. We present a unique case of hepatic splenosis in a patient with hemosiderosis and splenectomy following the incidental finding of hepatic masses on pretransplant imaging. Final diagnosis was made based on cross-sectional imaging characteristics matching that of the left upper quadrant splenules alone. We discuss common characteristics of hepatic splenosis on multiple modalities, the effect of iron deposition on the imaging characteristics of hepatic and splenic tissue and how that impacts the differential and diagnosis. This case highlights the unique imaging characteristics hepatic splenosis can have particularly in the setting of hemosiderosis. Hepatic splenosis imaging diagnosis has a significant advantage over tissue diagnosis in terms of decreased risk, time and cost.
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18
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Kripalani S, Patel V, Joneja U, Talwar S, Parikh M, Barshay V, Chaaya A. Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management. Cureus 2021; 13:e15891. [PMID: 34336412 PMCID: PMC8312822 DOI: 10.7759/cureus.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/20/2022] Open
Abstract
This case serves as a reminder to consider ectopic splenic tissue in the differential diagnosis of pancreatic masses. The literature shows a lack of awareness and overtreatment of this condition due to clinical and radiologic concern for malignancy, namely neuroendocrine tumors (NETs) identified on positron emission tomography (PET)-CT NETSPOT. Given the vast difference in management and prognosis of ectopic splenic anomalies and malignant neoplasms involving the pancreas, accurate diagnosis is imperative to avoid unnecessary invasive procedures such as Whipple or distal pancreatectomy and splenectomy, which are associated with increased morbidity and mortality.
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Affiliation(s)
- Simran Kripalani
- Department of Gastroenterology, Cooper Medical School of Rowan University, Camden, USA
| | - Vikram Patel
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
| | - Upasana Joneja
- Department of Pathology, Cooper University Hospital, Camden, USA
| | - Shikha Talwar
- Department of Medicine, Cooper University Hospital, Camden, USA
| | - Meet Parikh
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
| | - Veniamin Barshay
- Department of Radiology, Cooper University Hospital, Camden, USA
| | - Adib Chaaya
- Department of Gastroenterology, Cooper University Hospital, Camden, USA
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19
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Hines JJ, Mikhitarian MA, Patel R, Choy A. Spectrum and Relevance of Incidental Bowel Findings on Computed Tomography. Radiol Clin North Am 2021; 59:647-660. [PMID: 34053611 DOI: 10.1016/j.rcl.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. When suspicious incidental bowel wall thickening is detected, the radiologist can alert the clinical team to the finding prior to the patient becoming symptomatic, potentially leading to definitive management at an early, more curable stage.
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Affiliation(s)
- John J Hines
- Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Department of Radiology, Huntington Hospital, Northwell Health, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Mark A Mikhitarian
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ritesh Patel
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Andy Choy
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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20
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Tognarelli A, Faggioni L, Erba AP, Faviana P, Durante J, Manassero F, Selli C. Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report. World J Clin Cases 2021; 9:2868-2873. [PMID: 33969071 PMCID: PMC8058664 DOI: 10.12998/wjcc.v9.i12.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/26/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ‘Splenosis’ is defined as the autotransplantation of splenic tissue following trauma or surgery, usually in the form of intraperitoneal nodules. The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules, and achieving a differential diagnosis can be challenging. Nuclear medicine studies have been playing an increasingly important role in this process, but the clinical significance of asymptomatic nodules remains uncertain.
CASE SUMMARY We present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography (CT) follow-up for B-cell lymphoma, presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space. 18F-fluorodeoxyglucose demonstrated weak metabolic activity. Since histological diagnosis was deemed necessary, the nodule was easily removed with robotically assisted laparoscopy, together with another 6 mm left a paracolic lesion. The latter was previously undiagnosed but retrospectively visible on the CT scan.
CONCLUSION In a patient requiring differential diagnosis of splenosis nodules from lymphoma recurrence, the robotic approach provided a safe en bloc removal with short hospitalization. The Da Vinci Xi robot was particularly helpful because its optics can be introduced from all ports, facilitating visualization and lysis of multiple intra-abdominal adhesions.
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Affiliation(s)
- Alessio Tognarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy
| | - Lorenzo Faggioni
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Diagnostic and Interventional Radiology, University of Pisa, Pisa 56126, Italy
| | - Anna Paola Erba
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Nuclear Medicine, University of Pisa, Pisa 56126, Italy, Pisa 56126, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical and Molecular Pathology and Critical Area, Section of Pathology, University of Pisa, Pisa 56126, Italy
| | - Jacopo Durante
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy
| | - Francesca Manassero
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy
| | - Cesare Selli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy
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21
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Raab S, Hagleitner G, Motz R, Fellner FA, Shamiyeh A. Perirectal intraperitoneal splenosis: A case report of MRI with laparoscopic correlation. Radiol Case Rep 2021; 16:1543-1547. [PMID: 33948131 PMCID: PMC8081866 DOI: 10.1016/j.radcr.2021.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
Splenosis is a benign acquired condition, which appears after rupture of the spleen and heterotopic auto-transplantation. Mostly found as an incidental finding on cross-sectional imaging, definitive diagnosis is frequently made histologically after resection or tissue sampling. We report a case of a 36-year-old male patient who presented with increased susceptibility to infections, chronic fatigue, and a history of traumatic splenic rupture. Cross-sectional imaging showed perirectal formations within the mesorectal fascia, and extraperitoneal splenosis was suspected. Due to the radiologically unclear entity of the masses, diagnostic laparoscopy with tissue sampling was performed. Intraoperatively the masses turned out to be intraperitoneal. Histological workup showed splenic tissue, consistent with intraperitoneal splenosis after splenic rupture. In this article we want to discuss important imaging findings and their differentials, as well as clinical implications for this rare entity.
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Affiliation(s)
- Sandra Raab
- Department of General and Visceral Surgery, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Georg Hagleitner
- Central Radiology Institute, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Reinhard Motz
- Institute of Pathology and Molecular Pathology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Franz A Fellner
- Central Radiology Institute, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria.,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Shamiyeh
- Department of General and Visceral Surgery, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
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22
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Nadeem M, Tiwari HA, Jambhekar K, Shah H, Ram R. Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1721626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractThe spleen is the largest lymphatic organ and is responsible for both hematological and immunological functions. Several common etiologies such as trauma, developmental variants, infectious/inflammatory conditions, and benign and malignant lesions can occur in the spleen. The role of imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in diagnosing these conditions continues to evolve. The main objective of this review article is to illustrate the role of imaging in identifying the common and uncommon pathology of the spleen.
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Affiliation(s)
- Meshaal Nadeem
- Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hina Arif Tiwari
- Division of Radiology, Department of Medical Imaging, University of Arizona Health sciences, Tuscon, Arizona, United States
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hemendra Shah
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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23
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A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol (NY) 2021; 46:805-817. [PMID: 32949273 DOI: 10.1007/s00261-020-02736-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
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24
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Intussusception due to intramural jejunal splenosis. Pediatr Radiol 2021; 51:144-147. [PMID: 32666263 DOI: 10.1007/s00247-020-04731-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022]
Abstract
Splenosis is defined as the growth of ectopic splenic tissue, due to its direct seeding, usually seen after traumatic or surgical procedures to the spleen. It often occurs on highly vascularized surfaces such as the omentum or the mesentery, and grows in sessile form, supplied by adjacent vessels. Intestinal splenosis with endoluminal extension is extremely rare. We present a case of intestinal splenosis with endoluminal growth in a 14-year-old boy that provoked a small bowel intussusception requiring surgical resolution.
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25
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Usmani S, Muzaffar S, Rahman U, Al Kandari F, Ahmed N. A Very Unusual Pattern of Intraperitoneal and Extraperitoneal Heterotropic Splenic Tissue-Mimicking Metastases Identified on 68Ga-DOTA-NOC Positron Emission Tomography/Computed Tomography and 99mTc Heat-denatured Erythrocyte Study. Indian J Nucl Med 2020; 35:255-257. [PMID: 33082689 PMCID: PMC7537915 DOI: 10.4103/ijnm.ijnm_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 11/04/2022] Open
Abstract
The dissemination and autotransplantation of viable splenic tissue in different anatomic compartments of the body can present a diagnostic dilemma, especially when metastatic disease is suspected. We report a case of a 30-year-old male with well-differentiated gastric neuroendocrine tumor (Grade II) treated with surgery. Follow-up 68Ga-DOTA-NOC demonstrated a suspicious peritoneal soft-tissue nodule in the right paracolic gutter with increased tracer uptake. In view of splenectomy 10 years ago, the patient underwent 99mTc heat-denatured erythrocyte study which showed a very unusual pattern of multiple tracer-avid foci of splenic tissue in both intraperitoneal and extraperitoneal distributions. The integration of the patient's history and complementary nuclear imaging results led to the correct diagnosis of splenosis.
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Affiliation(s)
| | - Samreen Muzaffar
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Uzma Rahman
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - Najeeb Ahmed
- Department of Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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26
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Kawada S, Ichikawa T, Ueda H, Ito K, Inoue K, Mori K. A case of intrahepatic splenosis: usefulness of splenic scintigraphy. Abdom Radiol (NY) 2020; 45:2274-2278. [PMID: 32103300 DOI: 10.1007/s00261-020-02451-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a 39-year-old male with intrahepatic and peritoneal splenosis, focusing on scintigraphic findings. Dynamic computed tomography (CT) showed a 3 cm lesion in the posterior right lobe of the liver with strong early phase enhancement that was homogenous to the liver enhancement in the late phase. A few enhancing nodules were also found in the peritoneum. On gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced dynamic magnetic resonance imaging (MRI), the hepatic lesion had abnormal signal on diffusion-weighted imaging, high signal intensity on T2-weighted imaging, and early enhancement with accumulation decline in the hepatocyte phase. CT and MRI findings of the hepatic lesion were similar to normal spleen. To rule out hepatic neuroendocrine tumor and peritoneal metastases, somatostatin receptor scintigraphy was performed and showed tracer accumulation in the hepatic lesion, which we considered a false positive. Splenic scintigraphy using Tc-99 m-phytate showed accumulation in the hepatic lesion and peritoneal nodules. Given the patient's history of splenic injury and splenectomy 15 years prior and the current imaging findings, we highly suspected splenosis. After surgical treatment, the patient was pathologically diagnosed with intrahepatic and peritoneal splenosis. Splenosis should be suspected when a patient has a history of trauma or abdominal surgery. Since intrahepatic splenosis presents as a nonspecific hypervascular lesion on CT and MRI, splenic scintigraphy should be considered in these patients. In addition Tc-99 m-phytate scintigraphy is easy to use and cost-effective.
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27
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El-Helou E, Alimoradi M, Sabra H, Ghoussoub Y, Zaarour M, Abousleiman G. Small bowel obstruction due to splenosis 30 years after splenectomy. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32508109 DOI: 10.1308/rcsann.2020.0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.
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Affiliation(s)
- E El-Helou
- Lebanese University, Faculty of Medical Sciences, Mount Lebanon, Lebanon
| | - M Alimoradi
- Lebanese University, Faculty of Medical Sciences, Mount Lebanon, Lebanon
| | - H Sabra
- Lebanese University, Faculty of Medical Sciences, Mount Lebanon, Lebanon
| | - Y Ghoussoub
- Lebanese University, Faculty of Medical Sciences, Mount Lebanon, Lebanon
| | - Mariana Zaarour
- Lebanese University, Faculty of Medical Sciences, Mount Lebanon, Lebanon
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28
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Vernuccio F, Dimarco M, Porrello G, Cannella R, Cusmà S, Midiri M, Brancatelli G. Abdominal splenosis and its differential diagnoses: What the radiologist needs to know. Curr Probl Diagn Radiol 2020; 50:229-235. [PMID: 32540140 DOI: 10.1067/j.cpradiol.2020.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
Splenosis is a benign acquired condition characterized by the presence of heterotopic viable splenic tissue in other organs or within cavities such as peritoneum, retroperitoneum, or thorax after splenic trauma or surgery. Abdominal splenosis is often an incidental finding and computed tomography and magnetic resonance usually allow a confident diagnosis. The typical enhancement that parallels the spleen is a useful hallmark of splenosis. Splenic implants lack contrast uptake in the hepatobiliary phase and show high signal at high b-values on diffusion-weighted images. In some cases splenosis may mimic malignant and benign conditions in the peritoneum as well as in hollow and parenchymal abdominal organs and further investigations - including scintigraphy with Tc99m-labelled heat-denatured red blood cells or biopsy - are sometimes required in challenging cases. This pictorial essay reviews the imaging presentation and potential differential diagnosis of splenosis according to the site of implantation. A prompt and accurate radiological diagnosis of splenosis can avoid unnecessary biopsy or surgery.
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Affiliation(s)
- Federica Vernuccio
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G. D'Alessandro, University of Palermo, Palermo, Italy; I.R.C.C.S, Centro Neurolesi Bonino Pulejo, Messina, Italy; Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France.
| | - Mariangela Dimarco
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Giorgia Porrello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Roberto Cannella
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Silvestro Cusmà
- Radiology department, Oncologic Hospital "La Maddalena", Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
| | - Giuseppe Brancatelli
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy
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29
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Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, Middleton WD, Mellnick VM. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics 2020; 40:684-706. [PMID: 32330085 DOI: 10.1148/rg.2020190170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Parisa Mazaheri
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Daniel C Oppenheimer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
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30
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Abstract
Teaching point: Splenosis must be considered in patients with history of splenectomy or splenic trauma, later presenting with multiple peritoneal nodules.
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31
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Zhao Y, Maule J, McCracken J, Xing J, Wang E. Incidental finding of abdominal splenosis with mononucleated cell infiltration leading to a diagnosis of acute myeloid leukemia. Pathol Res Pract 2020; 216:152818. [PMID: 31964552 DOI: 10.1016/j.prp.2020.152818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/25/2022]
Abstract
Splenosis refers to ectopic splenic implants that are often found incidentally years after splenic rupture/splenectomy, and the nodules of splenosis are usually small, less than 3 cm for the majority. We report a case of splenosis with a 5-centimeter large mass in the anterior abdomen in a 79 year-old male with a remote history of splenic rupture/splenectomy. Unexpectedly, needle core biopsy of the abdominal mass demonstrated splenic tissue with a mononucleated cell infiltrate blurring the splenic architecture that was highlighted only by CD8 stain. This finding prompted a bone marrow examination resulting in the diagnosis of acute myeloid leukemia in the patient. Retrospectively, enlargement of this ectopic spleen may have been caused by this leukemic infiltrate. This case underscores the importance of being aware of this rare pathological condition and its retained vulnerability for involvement by hematolymphoid neoplasms, as well as significance of identifying splenic architecture highlighted by CD8 stain to reach a correct diagnosis.
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Affiliation(s)
- Yue Zhao
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, PR China; Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jake Maule
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jenna McCracken
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jalen Xing
- Department of Pathology, Duke University Medical Center, Durham, NC, USA; Summer Intern, CA, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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El-Kheir A, Abdelnour M, Boutros JG. Simultaneous small bowel and colon obstruction due to splenosis. A case report and review of literature. Int J Surg Case Rep 2019; 58:63-66. [PMID: 31009896 PMCID: PMC6479103 DOI: 10.1016/j.ijscr.2019.03.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Splenosis is an autotransplantation of splenic tissues throughout the body post splenic rupture or splenectomy. Symptomatic when hematological diseases have recurred. Abdominal splenosis may rarely be associated with abdominal pain and/or gastrointestinal symptoms. Further evaluation and treatment is mandatory when bowel obstruction is present. Treatment consists of resection of problematic splenic nodules.
Introduction Splenosis, an autotransplantation of splenic tissues in another compartment of the body, is only symptomatic when hematologic diseases have recurred or compression of other adjacent structures have occurred. Therefore, we report a clinical case of a patient with bowel obstruction due to splenosis. Case presentation A patient with a history of splenectomy, presented to the emergency room for abdominal pain and obstipation, suggesting intestinal obstruction which is also seen on CT scan. During laparotomy, multiple splenic nodules were seen on the mesentery of the small bowel and colon, with vascular bridges between them, resulting in bowel obstruction. Resection of splenic nodules was performed. The post-operative course was uneventful and the patient was discharged a week after. Discussion Although very rare, gastrointestinal symptoms may sometimes be described in patients with splenosis. Bleeding or obstruction can occur because of intramural grow or external compression, respectively. Treatment consists of resection of these nodules. Conclusion Splenosis should always be thought in patients with previous splenic rupture and presenting with incidental nodules seen on imaging, with further investigations when symptoms are present.
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Affiliation(s)
- Alaa El-Kheir
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon.
| | - M Abdelnour
- Department of Gastroenterology and Hepatology, Maritime Hospital, Jbeil, Lebanon
| | - Jihad G Boutros
- Department of General and Digestive Surgery, Maritime Hospital, Jbeil, Lebanon
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Kruger R, Freeman S. An unusual pelvic mass: Contrast-enhanced sonographic diagnosis of pelvic splenosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:172-174. [PMID: 30443965 DOI: 10.1002/jcu.22671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
Splenosis is an unusual condition representing auto-transplantation of splenic tissue following splenic trauma or surgery. When detected on imaging studies, the splenosis deposits are usually misinterpreted as pathological masses. We present a case where a pelvic mass incidentally visualized on an MRI examination, was proven to represent a deposit of splenosis by contrast enhanced ultrasound (CEUS). CEUS demonstrated persistent late-phase enhancement characteristic of splenic tissue. Ultrasound practitioners should be aware of this condition when an unusual abdominal or pelvic mass is encountered in a patient with a history of splenic trauma or surgery. CEUS is ideally suited to confirming the diagnosis.
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Affiliation(s)
- Ross Kruger
- South West Peninsula Training Scheme, Peninsula Radiology Academy, Plymouth International Business Park, Plymouth, PL6 5WR, United Kingdom
| | - Simon Freeman
- Department of Radiology, Imaging Directorate, University Hospitals Plymouth NHS Trust, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, United Kingdom
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Rodríguez Vargas D, Parada Blázquez M, Vargas Serrano B. Diagnostic imaging of abnormalities in the location of the spleen and in the number of spleens. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Rodríguez Vargas D, Parada Blázquez M, Vargas Serrano B. Diagnóstico por imagen de anomalías en el número y localización del bazo. RADIOLOGIA 2019; 61:26-34. [DOI: 10.1016/j.rx.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
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36
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Niu Y, Liu W, Xian L, Liu T, Huang C, Yang S. Thoracic splenosis presenting as pulmonary space-occupying lesion. BMC Surg 2018; 18:119. [PMID: 30572857 PMCID: PMC6302502 DOI: 10.1186/s12893-018-0461-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
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37
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Noriega E, Suils J, Bajén M, Benítez A, Rodríguez-Rubio J, Mora Salvadó J. Usefulness of 99mTc labelled heat-denatured red blood cell scintigraphy in the diagnosis of intramuscular splenosis. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Varghese J, Bergson J, Yaipen O. Intrahepatic Splenosis: Incidental Liver Lesion after Splenectomy. J Comput Assist Tomogr 2018; 42:730-731. [PMID: 29958200 DOI: 10.1097/rct.0000000000000762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the case of a 50-year-old man with history of remote splenectomy who underwent routine lung cancer screening chest computed tomography and was incidentally found to have a liver lesion. Dedicated liver protocol computed tomography demonstrated "archiform" enhancement pattern in the arterial phase and homogenous filling-in enhancement on portal venous and delayed phases. Multiple other smaller enhancing intraperitoneal lesions were also found. These findings along with history of splenectomy confirmed a diagnosis of intrahepatic and intraperitoneal splenosis and helped avoid biopsy. Intrahepatic splenules can be challenging to diagnose owing to its unusual location and similarity in appearance to a liver neoplasm or metastasis. However, careful evaluation of enhancement pattern and review of medical history can lead to an accurate diagnosis and avoidance of invasive biopsy.
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Affiliation(s)
| | - Jill Bergson
- Department of Radiology, Northport VA Medical Center, Northport
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Santos MA. Chronic Abdominal Pain from Disseminated Splenosis. J Gen Intern Med 2018; 33:976-977. [PMID: 29611090 PMCID: PMC5975174 DOI: 10.1007/s11606-018-4414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Michael A Santos
- WellSpan Good Samaritan Hospital, Lebanon, PA, USA. .,Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
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40
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Lemos AA, Crespi S, Costa S, Marini A. Splenosis of the abdomen and pelvis complicated by torsion of a splenic implant clinically mimicking an acute bowel ischemia. BJR Case Rep 2018; 4:20180024. [PMID: 30931139 PMCID: PMC6438399 DOI: 10.1259/bjrcr.20180024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/05/2022] Open
Abstract
We present a case of splenosis of the abdomen and pelvis complicated by torsion of a splenic implant in a young female patient clinically mimicking an acute bowel ischemia. Splenosis is a benign condition defined as heterotopic auto-transplantation of splenic tissue throughout different body areas. It may occur after rupture of the spleen, either traumatic or secondary to surgical procedures. Although the presence of heterotopic splenic tissue is often asymptomatic and an incidental finding, it may present with sudden abdominal pain and bleeding. CT and MRI play a critical role in the detection of splenosis-related complications, such as torsion of the vascular pedicle and infarction. Splenosis torsion is extremely rare and it is still a diagnostic dilemma; the complication of abdominal splenosis should be considered in the differential diagnosis in patients with previous splenectomy.
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Affiliation(s)
- Alessandro A Lemos
- Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | - Silvia Crespi
- Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | - Stefano Costa
- Department of General and Emergency Surgery, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | - Aldo Marini
- Department of General and Emergency Surgery, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
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41
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Marchi G, Avesani G, Zamò A, Girelli D. Unusual case of iron overload with cancer-mimicking abdominal splenosis. BMJ Case Rep 2018; 2018:bcr-2017-223410. [PMID: 29769185 DOI: 10.1136/bcr-2017-223410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 48-year-old man, former alcohol abuser and drug addicted, was referred to our tertiary referral centre for iron disorders because of marked hyperferritinaemia. His clinical history revealed chronic hepatitis C, ß-thalassaemia trait and post-traumatic splenectomy at age of 22. MRI-estimated liver iron content was markedly elevated, while first-line genetic test for haemochromatosis was negative. Alpha-fetoprotein was increased but liver ultrasonography did not reveal focal liver lesions. Multiphasic contrast-enhanced CT confirmed this result but showed two abdominal masses (diameter of 9 cm and 7 cm, respectively) among bowel loops, strongly suspicious for cancer. However, biopsy of one of the masses led to the final diagnosis of abdominal splenosis.
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Affiliation(s)
- Giacomo Marchi
- Department of Medicine, Unit of Internal Medicine, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Giacomo Avesani
- Department of Radiology, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Alberto Zamò
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Domenico Girelli
- Department of Medicine, Unit of Internal Medicine, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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42
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Noriega E, Suils J, Bajén MT, Benítez A, Rodríguez-Rubio J, Mora Salvadó J. Usefulness of 99mTc labelled heat-denatured red blood cell scintigraphy in the diagnosis of intramuscular splenosis. Rev Esp Med Nucl Imagen Mol 2018; 37:382-383. [PMID: 29636235 DOI: 10.1016/j.remn.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/07/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
Affiliation(s)
- E Noriega
- Departamento de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - J Suils
- Departamento de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, España
| | - M T Bajén
- Departamento de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, España
| | - A Benítez
- Departamento de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, España
| | - J Rodríguez-Rubio
- Departamento de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, España
| | - J Mora Salvadó
- Departamento de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, España
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43
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Ho A, Girgis S, Low G. Uncommon liver lesions with multimodality imaging and pathology correlation. Clin Radiol 2018; 73:191-204. [DOI: 10.1016/j.crad.2017.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/16/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
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44
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Van Hecke S, Wyngaert TVD, De Beeck BO, Stroobants S. Usefulness of Splenic Scintigraphy in Differentiating Splenosis and Malignancy on Gallium 68 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-NaI3-octreotide. World J Nucl Med 2018; 17:56-58. [PMID: 29398968 PMCID: PMC5778717 DOI: 10.4103/wjnm.wjnm_1_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Somatostatin receptor (SSTR) imaging with gallium 68 (Ga-68) 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-peptide positron emission tomography/computed tomography (PET/CT) has been introduced in clinical routine for the diagnosis and staging of neuroendocrine tumors (NETs) with high SSTR expression. Although it has high sensitivity for NETs, there are some known diagnostic pitfalls one should be aware of. We present a case of suspected NET where Ga-68 DOTA-NaI3-octreotide (NOC) PET/CT showed several abdominal lesions with high SSTR expression suggesting malignancy. On magnetic resonance imaging, the differential diagnosis of the lesions also included splenosis. Subsequent splenic scintigraphy with technetium-99m phytate showed uptake in all suspicious lesions, and biopsy confirmed the diagnosis of splenosis. Splenic scintigraphy with single-photon emission computed tomography/CT can be a helpful noninvasive diagnostic tool when splenosis is suspected on Ga-68 DOTA-peptide PET/CT.
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Affiliation(s)
- Stijn Van Hecke
- Department of Nuclear Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Tim Van Den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Bart Op De Beeck
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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45
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Buisson G, Maissiat E, Dubernard G, Boussel L. [Pelvic nodules in a young woman: All is not endometriosis!]. J Gynecol Obstet Hum Reprod 2017; 46:197-200. [PMID: 28403978 DOI: 10.1016/j.jogoh.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
Splenosis is a pathology resulting from a rupture of the spleen due to a trauma or a surgery. We report the case of a patient presenting with a splenosis, initially diagnosed as endometriosis-related pelvic nodules, the most frequent cause of pelvic nodules in women. We will describe the imaging strategy that led to the final diagnosis of splenosis.
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Affiliation(s)
- G Buisson
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - E Maissiat
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Dubernard
- Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - L Boussel
- Service de radiodiagnostic et d'imagerie médicale, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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46
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Lameiras R, Matos AP, Luz C, Palas J, Ramalho M. Pelvic splenosis-a very unusual location. BJR Case Rep 2017; 3:20160026. [PMID: 30363257 PMCID: PMC6159209 DOI: 10.1259/bjrcr.20160026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 12/05/2016] [Accepted: 01/26/2017] [Indexed: 12/03/2022] Open
Abstract
We present a rare case of pelvic splenosis, and its imaging findings, in a 54-year-old female complaining of pelvic pain and vaginal bleeding for several months. Splenosis is a benign acquired condition defined as heterotopic auto-transplantation of splenic tissue to other compartments of the body and occurs after rupture of the spleen, either traumatic or iatrogenic. Symptoms are unspecific and vary according to the location of the implants; commonly the presenting symptom is abdominal pain or enlarging abdominal mass. Owing to its intrinsic properties and safety, magnetic resonance imaging is a valuable imaging modality, in which the splenosis implants may be securely identified, showing the same signal characteristics and enhancing patterns of the normal spleen, especially visualization of serpiginous enhancement on the arterial phase is virtually diagnostic.
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Affiliation(s)
- Raquel Lameiras
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Carlos Luz
- Department of Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - João Palas
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
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47
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Matthews A, Chesser M, Mand J, Thomas A. A Growth Opportunity: Thoracic Splenosis. Am J Med 2017; 130:420-422. [PMID: 27913101 DOI: 10.1016/j.amjmed.2016.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Abby Matthews
- Division of Internal Medicine, Department of Medicine, Banner University Medical Center, Phoenix, Ariz; Division of Internal Medicine, Phoenix Veterans Affairs Health Care System, Ariz.
| | - Michael Chesser
- Division of Internal Medicine, Phoenix Veterans Affairs Health Care System, Ariz
| | - Jasminder Mand
- Division of Pulmonology and Critical Care Medicine, Phoenix Veterans Affairs Health Care System, Ariz
| | - Allen Thomas
- Division of Pulmonology and Critical Care Medicine, Phoenix Veterans Affairs Health Care System, Ariz
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48
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Somsap K, Chamadol N, Titapun A, Pairojkul C, Sangkhamanon S. MR imaging findings of a patient with isolated intrahepatic splenosis mistaken for hepatocellular carcinoma. BJR Case Rep 2016; 3:20150242. [PMID: 30363334 PMCID: PMC6159292 DOI: 10.1259/bjrcr.20150242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 06/13/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022] Open
Abstract
Splenosis refers to the autotransplantation of splenic tissue throughout different anatomic compartments secondary to trauma or splenic surgery. The liver is an uncommon location for splenic implants and imaging findings are often described as non-specific. We report MRI findings of a patient with a large liver mass that was first diagnosed as a malignant tumour but histopathology revealed that it was actually intrahepatic splenosis. The signal characteristics of this mass were low intensity on T1 and high intensity on T2 weighted images; arterial enhancement, which became more homogeneous in the later phases; and a relative hypointensity on the delayed phase images. Because a high level of awareness is necessary for making a correct diagnosis of this condition, one should consider the possibility of intrahepatic splenosis in a patient with a history of abdominal trauma or splenic surgery.
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Affiliation(s)
- Kulyada Somsap
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nittaya Chamadol
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Attapol Titapun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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49
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Desbuquoit D, Van Hecke S, Even P, Parizel PM, van Meerbeeck JP, Snoeckx A. Pleural Nodules and Mediastinal Lymphadenopathy in a Smoker: An Unusual Case Report. Case Rep Oncol 2016; 9:488-492. [PMID: 27721773 PMCID: PMC5043224 DOI: 10.1159/000448803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022] Open
Abstract
The authors report a case of thoracic splenosis, which is the autotransplantation of splenic tissue into the pleural cavity. Splenosis in the chest is a rare entity and most often an incidental finding on chest computed tomography, typically showing solitary or multiple well-defined, noncalcified pleural nodules of variable size in the left hemithorax. It is important to include this benign pathology in the differential diagnosis among other, generally malignant, pleural lesions. Imaging clues to the diagnosis are absence of the spleen and/or associated rib fractures. Early identification of thoracic splenosis as a cause of pleural nodules can prevent unnecessary and risky invasive procedures, such as biopsy or surgery.
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Affiliation(s)
- Damien Desbuquoit
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Stijn Van Hecke
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Pjotr Even
- Department of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Jan P van Meerbeeck
- Department of Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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50
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Kutara K, Konno T, Kondo H, Aoki K, Yamazoe H, Matsunaga S. IMAGING DIAGNOSIS-ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA-ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE-PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG. Vet Radiol Ultrasound 2016; 58:E26-E30. [PMID: 27377289 DOI: 10.1111/vru.12395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/28/2016] [Indexed: 01/16/2023] Open
Abstract
A 10-year-old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple-phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra-abdominal solid masses. In triple-phase helical computed tomography the images, hepatic mass and two of four intra-abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra-abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.
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Affiliation(s)
- Kenji Kutara
- Companion Animal Medical Imaging Center, 3-5-7 Hisamoto, Takatsu, Kawasaki, Kanagawa, Japan
| | - Toshiaki Konno
- Synergy Animal General Hospital, 815 Ishigami Kawaguchi, Saitama, 333-0823, Japan
| | - Hirotaka Kondo
- Synergy Animal General Hospital, 815 Ishigami Kawaguchi, Saitama, 333-0823, Japan
| | - Kotoyo Aoki
- Companion Animal Medical Imaging Center, 3-5-7 Hisamoto, Takatsu, Kawasaki, Kanagawa, Japan
| | - Hinako Yamazoe
- Companion Animal Medical Imaging Center, 3-5-7 Hisamoto, Takatsu, Kawasaki, Kanagawa, Japan
| | - Satoru Matsunaga
- Companion Animal Medical Imaging Center, 3-5-7 Hisamoto, Takatsu, Kawasaki, Kanagawa, Japan
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